WPADE.org

Hyperglycemic Hyperolmolar Non Ketosis (HHNK) is an acute complication of diabetes associated with non insulin dependent diabetes. The insulin produced is enought to prevent ketoacidosis, but not hyperglycemia or hyperolmolality. An elevated BUN, reflecting the decreased renal perfusion that results from hypovolemia, characterizes this condition. HHNK can be related to stress and has an onset from days to weeks after illness or surgery or physical stress. It is more common in older patients and may have a mortality rate as high as 50% if untreated immediately. If the patient is either unable to recognize thirst or unable to keep down liquids, ther is a higher mortality rate depending on the degree of hyperosmolality. If severely dehydrated, a hypotonic solution must be rapidly infused until the osmolality normalizes and the blood glucose level stablizes. Electrolytes must be monitored, especially for potassium and sodium. The elderly are more intolerant of extremes in electrolyte levels, consequently they must be checked more frequently using both serum and cardiac monitoring. Cerebral dehydration can accompany HHNK so neuro status should also be evaluated and precautions taken to prevent seizures. Another complication of this condition that can develop is pulmonary edema, especially in those with kidney failure or older patients.
Annette Karnash